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    How To Read Electrocardiography: SMF Kardiologi Dan Kedokteran Vaskular RSUD Tanjung Pura Langkat

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    Haziq Mars
    This document provides information on how to read electrocardiograms (EKGs). It discusses standardizing EKG speed, electrode placement, lead systems, cardiac conduction, normal EKG waves, and how to interpret EKGs. Key points covered include determining heart rate and axis, identifying normal sinus rhythm, signs of hypertrophy, myocardial infarction patterns, and types of arrhythmias like different degrees of atrioventricular block. Diagrams are provided to illustrate electrode positions, cardiac conduction, and infarction locations.

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    How To Read Electrocardiography: SMF Kardiologi Dan Kedokteran Vaskular RSUD Tanjung Pura Langkat

    Uploaded by

    Haziq Mars
    155 views95 pages
    This document provides information on how to read electrocardiograms (EKGs). It discusses standardizing EKG speed, electrode placement, lead systems, cardiac conduction, normal EKG waves, and how to interpret EKGs. Key points covered include determining heart rate and axis, identifying normal sinus rhythm, signs of hypertrophy, myocardial infarction patterns, and types of arrhythmias like different degrees of atrioventricular block. Diagrams are provided to illustrate electrode positions, cardiac conduction, and infarction locations.

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    ekg

    Original Title

    Ecg Interpretation Zai1

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    This document provides information on how to read electrocardiograms (EKGs). It discusses standardizing EKG speed, electrode placement, lead systems, cardiac conduction, normal EKG waves, and how to interpret EKGs. Key points covered include determining heart rate and axis, identifying normal sinus rhythm, signs of hypertrophy, myocardial infarction patterns, and types of arrhythmias like different degrees of atrioventricular block. Diagrams are provided to illustrate electrode positions, cardiac conduction, and infarction locations.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    155 views95 pages

    How To Read Electrocardiography: SMF Kardiologi Dan Kedokteran Vaskular RSUD Tanjung Pura Langkat

    Uploaded by

    Haziq Mars
    This document provides information on how to read electrocardiograms (EKGs). It discusses standardizing EKG speed, electrode placement, lead systems, cardiac conduction, normal EKG waves, and how to interpret EKGs. Key points covered include determining heart rate and axis, identifying normal sinus rhythm, signs of hypertrophy, myocardial infarction patterns, and types of arrhythmias like different degrees of atrioventricular block. Diagrams are provided to illustrate electrode positions, cardiac conduction, and infarction locations.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    of 95

    HOW TO READ

    ELECTROCARDIOGRAPHY

    SMF Kardiologi dan Kedokteran Vaskular


    RSUD Tanjung Pura
    Langkat

    STANDARISASI EKG
    Kecepatan kertas standard EKG
    25 mm / s (10 25 50 mm / s
    Setiap kolom horizontal = 0.04 sec
    Setiap kolom vertikal 10 mm = 1 mV

    PEMASANGAN ELEKTRODE
    PEMASANGAN ELEKTRODE EXTREMITAS
    Lengan kanan dan lengan kiri
    Kaki kanan dan kaki kiri

    PEMASANGAN ELEKTRODE DADA

    V1 = Parasternal kanan di ICS-4


    V2 = Parasternal kiri di ICS-4
    V4 = MCL kiri di ICS-5
    V3 = Median antara V2 dgn V4
    V5 = Para Axillair Line kiri di ICS-5
    V6 = Median Axillair kiri di ICS-5

    SISTEM LEADS
    STANDARD LIMB LEADS
    I, II, III

    AUGMENTED UNIPOLAR LIMB LEADS


    aVR, aVL, aVF

    UNIPOLAR CHEST LEADS

    V1, V2, V3, V4, V5, V6


    V3R, V4R, V5R, V6R
    V7, V8, V9
    V7R, V8R, V9R

    Unipolar Precodial (Chest) Leads


    Midclavicular line
    Anterior axillary line
    Midaxillary line

    V6

    V6R
    V5R
    V4R

    V3R

    V5

    V4

    V3

    V2
    V1

    Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of
    California School of Medicine San Francisco @1995-1982

    Unipolar Precodial (Chest) Leads

    Horizontal plane of
    V4-6

    V7 V8 V9

    V9RV8RV7R

    Mervin J. Goldman, MD. 11th edition Principles of clinical Electrocardiography. Clinical Professor of Medicine University of
    California School of Medicine San Francisco @1995-1982

    Conduction System

    SA Node
    Internodal branch
    AV Node
    Hiss Bundle
    Purkinje Fiber
    Contraction

    The Electrocardiogram ( ECG )


    P wave : atrial
    depolarisation
    QRS complex :
    ventricular
    depolarisation
    T wave : ventricular
    repolarisation
    Atrial repolarisation
    hidden by QRS

    ECG INTERPRETATION
    1.
    2.
    3.
    4.
    5.
    6.

    RHYTM
    RATE
    AXIS
    HIPERTROPHIC SIGNS
    MYOCARDIAL INFARCTION
    ARRHYTHMIA

    1. RHYTHM
    Normal cardiac rhythm : SINUS rhythm
    Sinus rhythm characteristics :
    Rate 60-100 bpm
    Constant R R interval
    Negative P wave in aVR and positive di II
    P wave is always followed by QRS complex

    Normal Sinus Rhythm


    Rhythm : Regular
    Rate : 60 100
    P wave : Normal in configuration; precede each QRS
    PR
    : Normal ( 0. 12 0.20 seconds )
    QRS : Normal ( less than 0.12 seconds )

    MENGHITUNG DENYUT JANTUNG :

    2. RATE
    Normal heart rate : 60 100 x/minutes
    > 100 x/minutes : Sinus Tachycardia
    < 60 x/minutes
    : Sinus Bradicardia

    Determination heart rate (normal paper speed 25 mm/s):

    300
    Count number of large square (bold boxes in one R R interval)

    1500
    Count number of small square in one R R intervals

    Number of QRS complex in 6 seconds, multiply by 10

    MENENTUKAN AXIS EKG


    Menghitung Axis:
    Sudut yang dibuat oleh tingginya voltage R di I
    dengan tingginya voltage R di aVF
    Axis yg normal berada antara -30 dgn +90
    Left Axis Dev berada antara -30 dgn -90
    Right Axis Dev berada antara +90 dgn +180
    I

    3. AXIS

    Menentukan Axis

    P Wave

    4. HYPERTROPHIC SIGNS

    P Pulmonale

    P Mitrale

    PR Interval

    AV BLOCK

    Wolff-Parkinson-White syndrome

    QRS Complex

    ST Segment

    T Wave

    ST depresi dan perubahan gelombang T


    ST depresi dianggap bermakna bila > 1 mm di bawah garis dasar PT di titik J
    Titik J didefinisikan sebagai akhir kompleks QRS dan permulaan segmen ST
    Bentuk segmen ST :
    up-sloping ( tidak spesifik )
    horizontal ( lebih spesifik untuk iskemia )
    down-sloping ( paling terpercaya untuk iskemia )

    Perubahan gelombang T pada


    iskemia kurang begitu spesifik
    Gelombang T hiperakut
    kadang2 merupakan satu-satunya
    perubahan EKG yang terlihat

    Anatomi Koroner dan EKG 12 sandapan


    Sandapan V1 dan V2 menghadap septal area ventrikel kiri
    Sandapan V3 dan V4 menghadap dinding anterior ventrikel kiri
    Sandapan V5 dan V6 ( ditambah I dan avL ) menghadap
    dinding lateral ventrikel kiri
    Sandapan II, III dan avF menghadap dinding inferior ventrikel kiri

    5. MYOCARDIAL INFARCTION
    Ischemia
    Injury
    Necrosis

    ANTERIOR INFARCTION

    INFERIOR INFARCTION

    POSTEROLATERAL INFARCTION

    Acute anteroseptal myocardial infarction.


    Hyperacute T-wave changes are noted

    Acute anterolateral myocardial infarction

    Acute inferoposterior myocardial infarction

    LVH

    LVH

    LVH

    RV
    H

    RVH

    RVH

    ARRHYTHMIA

    First-degree AV block

    Rhythm : Regular
    Rate : Usually normal
    P wave : Sinus P wave present; one P wave to each QR
    PR
    : Prolonged ( greater than 0.20 seconds )
    QRS
    : Normal

    AV BLOCK

    Second -degree AV block, Mobitz I


    Rhythm : Irregular
    Rate : Usually slow but can be normal
    P wave : Sinus P wave present;
    some not followed by QRS complexes
    PR
    : Progressively lengthens
    QRS
    : Normal

    Second-degree AV block, Mobitz II


    Rhythm : Regular usually;
    can be irreguler if conduction ratios vary
    Rate : Usually slow
    P wave : Two, three, or four P waves before each QRS
    PR
    : PR interval of beat with QRS is constant;
    PR interval may be normal or prolonged
    QRS
    : Normal if block in His bundle;
    wide if block involves bundle branches

    Third-degree AV block

    Rhythm : Regular
    Rate : 40 60 if block in His bundle;
    30 40 if block involves bundle branches
    P wave : Sinus P wave present; bear no relationship to QRS
    can be found hidden in QRS complexes and T wav
    PR
    : Varies greatly
    QRS : Normal if block in His bundle;
    wide if block involves bundle branches

    Supraventricular tachycardia

    Wide complex tachycardia

    Ventricular flutter

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